Cardiac Flashcards
(132 cards)
1
Q
Calculation for anion gap
A
(Na + K) - (Cl + HCO3)
2
Q
Metabolic acidosis is defined by….
A
A decrease in HCO3
3
Q
Respiratory acidosis is defined by…
A
Increase in CO2
4
Q
What is pericardial tamponade
A
Filling of the pericardial sac with fluid
5
Q
Signs of cardiac tamponade
A
- Narrow pulse pressure
- Elevated CVP
- Distant heart sounds
6
Q
Hemodynamic goals when managing a patient with mitral or aortic regurgitation
A
- Keep SVR low to maintain forward flow and decrease regurgitant fraction
- High normal HR to decrease time in diastole and decrease regurgitant fraction
7
Q
Pharmacologic support during cardiac tamponade
A
Increase HR and contractility to maintain cardiac output
8
Q
What is pulseless electrical activity
A
An EKG rhythm that should produce a pulse but does not
9
Q
Treatment for pulseless electrical activity
A
CPR, defibrillation, epi
10
Q
Signs of right heart failure
A
- Peripheral edema
- Hepatomegaly
- Coagulopathy
11
Q
Signs of left ventricular failure
A
- Dizziness
- Pulmonary edema
- Paroxysmal nocturnal dyspnea
- Orthopnea
- Coughing
12
Q
A silent MI is associated with what disease
A
Diabetes
13
Q
Atrial kick is responsible for what percentage of stroke volume
A
20-30%
14
Q
What is dromotropy
A
Rate of AV node conduction
15
Q
What is lusitropy
A
Rate of cardiac relaxation
16
Q
What is NOT a good indicator of volume status in a renal patient?
A
Urine output
17
Q
Factors affecting myocardial oxygen consumption
A
- Heart rate
- Contractility
- Preload
- Afterload
18
Q
Myocardial oxygen extraction
A
Myocardium extracts 65% of oxygen in arterial blood
19
Q
Equation for SVR
A
80*(MAP-CVP) / CO
20
Q
Normal values for SVR
A
700-1600 dynes
21
Q
Equation for PVR
A
80*(PAP-PCWP) / CO
22
Q
Normal values for PVR
A
20-130 dynes
23
Q
ACLS dose for vasopressin
A
40 units
24
Q
Treatment of asystole after chest closure following AVR
A
Chest compressions
25
Treatment of ventricular fibrillation
- Defibrillation
- 1mg epi
- 300mg amiodarone
26
Treatment of ventricular tachycardia
- 300mg amiodarone
| - 1mg/kg lidocaine
27
Anesthetic management for cardiomyopathy
Treat hemodynamics with beta blockers and calcium channel blockers - NO INOTROPES
28
Anesthetic techniques for patients with pulmonary hypertension
- Nitric oxide therapy
- PEEP
- Hyperventilation
- Correct acidosis
- Deepen anesthetic
- Milrinone
- Avoid N2O because it increases PVR
29
Perioperative management of AICD
- Interrogate defibrillator
- Contact manufacturer
- Disable AICD
30
Indications for IABP
Inability to come off bypass with inotropes and pressors
31
Contraindications to IABP placement
- Aortic insufficiency
| - Aortic dissection
32
Delay of elective, noncardiac surgery following an acute MI
30 days
33
Preparation for redo sternotomy
- R2 pads
| - Type and crossed units of blood available in the room
34
Drugs and conditions to avoid in obstructive hypertrophic cardiomyopathy
- PDIs
| - Inotropes
35
Management of obstructive hypertrophic cardiomyopathy
- Treat with beta blockers and CCBs
- Alpha agents good for blood pressure treatment
- Avoid hypovolemia
- Avoid sympathetic stimulation (beta 1)
36
Clinical findings in cardiomyopathy
- SOB
- Angina
- Dyspnea
37
Pathophysiology of obstructive hypertrophic cardiomyopathy
Dynamic obstruction of LV outflow during systole
38
Treatment of hypotension in obstructive hypertrophic cardiomyopathy
A1 agonist
39
Anesthetic management during CPB is the responsibility of...
The perfusionist
40
Anesthetist's responsibility during CPB
- Background pressors
- Urine output
- Monitor MAPs
- Monitor bladder temp
- Running TXA
41
Carbon dioxide use during hypothermic CPB
Sprayed in an open vessel to avoid air embolism
42
Dose of heparin for CPB
400units/kg
43
MAP goal during CPB
60-80mmHg
44
Minimum ACT needed to initiate CPB
400
45
Normal blood flow rate for adult on total CPB
4-5L/min
46
How much is oxygen consumption decreased during cooling on CPB
7% per degree celsius
47
Where is cardioplegia injected during retrograde cardioplegia
Coronary sinus
48
Heart sounds associated with mitral valve prolapse
Mid systolic click
49
Assessing heparinization during CPB
ACT is taken every 30 minutes
50
Blood product used to increase fibrinogen
Cryo
51
Antithrombin III deficiency and hepariniztion
Heparin increases the activity of ATIII so if the patient is deficient the heparin will not work efficiently
52
Elimination half life of heparin
1.5 hours
53
Management of hypofibrinogenemia
Give cryo
54
Normal range for ACT
80-120
55
Morbidity and mortality for off-pump CABG
10% morbidity, 2.3% mortality
56
Morbidity and mortality for on-pump CABG
14% morbidity, 2.9% mortality
57
Acute and long term management for CHF
Acute - vasodilators, diuretics, PPV
| Long term - ACE inhibitors, diuretics, beta blockers, AICD, heart transplant
58
Pathophysiology of heart failure
Hypertrophy of the ventricle leading to an increased stiffness
59
Oxygen demand breakdown of myocardium
64% pressure work
20% basal
15% volume work
1% electrical activity
60
Etiology of left lateral wall infarction
Circumflex
61
Etiology of anterior wall infarction
LAD
62
Etiology of inferior wall infarction
Right coronary
63
Etiology of posterior wall infarction
Right coronary
64
Most sensitive monitor for left ventricular ischemia
EKG - Leads II, V4, V5
65
Risk factors for ischemic heart disease
- Hyperlipidemia
- HTN
- Smoking
- High BMI
66
Infusion rate of norepinephrine
4-12mcg/min (0.05mcg/kg/min)
67
Infusion rate of epinephrine
4-12mcg/min
68
Infusion rate of milrinone
0.375-0.75mcg/kg/min
69
Infusion rate of vasopressin
2-8 units/hr
70
Infusion rate of phenylephrine
25-100mcg/min (0.1-1mcg/kg/min)
71
Infusion rate of NTG
0.5-10mcg/kg/min
72
Infusion rate of NTP
0.5-10mcg/kg/min
73
Infusion rate of nicardipine
5mg/hour
74
Infusion rate of insulin
2-6units/hr
75
Infusion rate of fentanyl
0.5-5mcg/kg/hour
76
Infusion rate of esmolol
50-300mcg/kg/min
77
Cardiac drugs without inotropic effects
- Phenylephrine
| - Vasopressin
78
Management of vtach when lidocaine fails
300mg amiodarone
79
Drug treatment of RV failure secondary to high PVR
Milrinone
80
Drug treatment of myocardial ischemia
NTG
81
Contraindications of TEE
- Surgery on stomach/esophagus
| - Esophageal stricture/spasm/laceration/perforation/diverticula
82
Indications for intra-operative TEE
- Suspected embolism
- Infective endocarditis
- Valvular heart disease
- Detection of intracardial mass
- Congenital heart disease
- Ischemic heart disease
83
Calculation of cardiac index
CO/BSA
84
Calculation of stroke volume
EDV-ESV
85
Myocardial dysfunction with hypocalcemia
- Hypokinesia
| - Prolonged QT
86
Absence of A wave on CVP tracing is indicative of
A fib
87
ECG lead that detects left ventricular ischemia
V5
88
Symptom of myocardial ischemia
Jaw pain
89
Management of vtach when shock therapy fails
Amiodarone
90
Effect of desflurane on PVR
increases
91
Normal lactate
0.5-2.2mmol/L
92
Normal calcium levels
1.19-1.33mmol/L
93
Normal magnesium levels
0.7-1mmol/L
94
Trans valvular gradient in critical aortic stenosis
Greater than 50mmhg
95
Probable cause of death in untreated pulmonary hypertension
Right ventricle failure
96
Treatments for acute pulmonary hypertension
Increase FiO2, hyperventilation, adequate analgesia, nitric oxide, prostaglandin
97
Factors that increase PVR
Hypoxia, hypercarbia, acidosis, pain, N2O
98
Etiology of anterior MI
Left main occlusion
99
Major risk factor for complications during CABG
CHF
100
Transfusion trigger for PRBCs
Hgb of 7 or Hct under 21
101
Transfusion trigger for platelets
Platelets under 100K
102
Treatment for decreased factors 8, 12, and vWF
Desmopressin 0.3mcg/kg
103
Treatment for decreased coagulation factors
FFP
104
Issue associated with massive transfusion of PRBCs
Hypocalcemia and citrate toxicity
105
Determination of preload with an ECHO
Assess LVEDV via LV EDA using transgastric short axis view
106
What lab should be checked in the case of a persistent AV block following CPB
K+, if high treat with calcium, nahco3, lasix, or glucose + insulin
107
Interpretation of peaked T waves following CPB
Hyperkalemia
108
Interpretation of prolonged QT interval following CPB
Hypocalcemia
109
Interpretation of irregular rhythms following CPB
Hypomagnesium
110
Normal range for Cl-
110-110
111
Treatment for postop shivering
25mg meperidine
112
Mortality with untreated pulmonary hypertension
30% within 3 years
113
Method of administering platelets
Room temperature 150 micron filter
114
Transfusions are indicated for cardiac surgery when the Hgb is below
7
115
Transfusions are indicated for cardiac surgery when the Hct is below
21
116
Transvalvular gradient in critical aortic stenosis
Over 50mmHg
117
Management of Vtach when shock therapy fails
Amiodarone
118
Effect of Des on PVR
Increases
119
Normal lactate values
0.5-2.2 mmol/L
120
Normal calcium levels
1.2-1.3 mmol/L
121
Normal magnesium levels
0.7-1 mmol/L
122
Electrolyte imbalance that is possible after transfusing a lot of PRBCs
Hypocalcemia bc the calcium binds to the citrate in the packed rbcs
123
Non-anion gap metabolic acidosis is associated with what electrolyte imbalance
Hyperchloremia
124
Core body temp must be at least __ degrees celsius before separating from CPB
37
125
Requirements for coming off pump
- Normal core temp
- Hgb at appropriate level
- Normal HR/rhythm
- 100% FiO2
126
When performing TEE, how do you determine preload
LVEDV
127
Old man comes off bypass but wont stop bleeding. Platelets are 150k and fibrinogen is 80. What should your initial treatment be?
Cryo
128
Most dangerous patient risk factor when undergoing CABG
CHF
129
Highest morbidity and mortality in CABG is concomitant with what comorbidity
CHF
130
If a patient has diastolic dysfunction they will most likely have a reduction in what volume
Stroke volume
131
Common symptom of myocardial ischemia
Jaw pain
132
Probable cause of death with untreated pulmonary hypertension
Right heart failure
